Cath Lab Digest

While conducting a study to see if an evidence-based algorithm for wound care worked in the real world,¹ we noticed that some patients’ wounds stopped progressing when nearly healed. Data analysis showed that their caregivers were switching to gauze dressings. When asked why, they said it was “because the wound was almost healed and didn’t need evidence-based dressings any more.” The care-givers were acting as though time would heal the wounds.

Today we know this is nonsense. Those caregivers might have changed their minds about time healing wounds if they had tracked progress for 2 to 4 weeks after changing the protocol of care. Wound area reduction during the first few weeks of care is a strong predictor of healing for pressure ulcers,² diabetic foot ulcers,^3,4 or venous ulcers.^5,6 Kurd et al⁷ recently showed that care providers alerted to venous and diabetic ulcers not on the normal healing curve after 4 weeks of care improved their patients’ healing outcomes.

Wound care providers and patients: you can put time on your side by monitoring if an ulcer is or is not responding to treatment. Healing is likely if a pressure ulcer’s area reduces at least 39% during the first 2 weeks of care²; if a venous ulcer reduces in area at least 30% in 2 weeks⁶ or 40% in 3 weeks⁵; or if a diabetic foot ulcer reduces in area at least 50% in 4 weeks.^3,4 If not, take action! All you need is a ruler to measure longest wound length and width each week. This robustly estimates wound area reduction and predicts nonhealing.⁸

If you’d like an EXCEL file to alert you to these benchmarks when you enter the date of measurement, longest length, and width of for your favorite ulcers during weeks 1 to 4 of new care, please contact the Editor (bzeiger@hmpcommunications.com).

References
1. Bolton L, McNees P, van Rijswijk L, et al. Wound healing outcomes using standardized care JWOCN. 2004;31(3):65–71.
2. van Rijswijk L, Polansky M. Predictors of time to healing deep pressure ulcers. Wounds. 1994;6(5):159–165.
3. Sheehan P, Jones P, Caselli A, Giurini J, Veves A. Percent change in wound area of diabetic foot ulcers over a 4-week period is a robust predictor of complete healing in a 12-week prospective trial. Diabetes Care. 2003;26(6):1879–1882.
4. Snyder RJ, Hanft JR. Diabetic foot ulcers — effects on quality of life, costs, and mortality and the
role of standard wound care and advanced-care therapies in healing: a review. Ostomy Wound Manage. 2009;55(11):28–38.
5. Phillips TJ, Machado F, Trout R, Porter J, Olin J, Falanga V, and The Venous Ulcer Study Group. Prognostic indicators of venous ulcers. J Am Acad Dermatol. 2000;43:627–630.
6. van Rijswijk L. and the Multi-Center Leg Ulcer Study Group. Full-thickness leg ulcers: patient demographics and predictors of healing. J Family Pract. 1993;36(6):625–632.
7. Kurd SK, Hoffstad OJ, Bilker WB, Margolis DJ. Evaluation of the use of prognostic information for the care of individuals with venous leg ulcers or diabetic neuropathic foot ulcers. Wound Repair Regen. 2009;17(3):318–325.
8. Kantor J, Margolis DJ. Efficacy and prognostic value of simple wound measurements. Arch Dermatol. 1998;134:1571–1574.